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Cephalomedullary nail
8%
222/2822
External fixation
218/2822
Proximal femoral locking plate
2%
67/2822
95 degree blade plate
1%
41/2822
Sliding hip screw
80%
2265/2822
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The image shows a reverse obliquity intertrochanteric hip fracture. According to the referenced article by Haidukewych et al, unstable peritrochanteric hip fractures have a worse outcome (failed in 9/16 cases) if treated with a sliding hip screw. Two additional factors that were found to have a strong correlation with postoperative failure (nonunion, loss of reduction) were poor reduction and poor implant placement. In this study, fixed angle devices were superior. Intramedullary fixation has the added advantage of a shorter lever arm and less potential for fracture collapse and limb shortening. The IMN also acts as a medial buttress. According to Sanders et al, the dynamic condylar screw (DCS) can also be used in subtrochanteric models, but should not be used if extensive comminution is seen, as they reported a high failure rate with DCS in these fractures if highly comminuted. They report a 77% overall union rate with this device.
2.5
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